Provider Demographics
NPI:1689468670
Name:KALISH, KOURTNIE BEVERLY PAIGE
Entity type:Individual
Prefix:
First Name:KOURTNIE
Middle Name:BEVERLY PAIGE
Last Name:KALISH
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3026 S 39TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68105-3428
Mailing Address - Country:US
Mailing Address - Phone:402-906-9559
Mailing Address - Fax:
Practice Address - Street 1:7802 HOWARD ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-5419
Practice Address - Country:US
Practice Address - Phone:402-689-7333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider